Do forecasts of UV indexes influence people's outdoor behaviour?

Predicting sun protection measures against skin diseases using machine learning approaches

BACKGROUND

The substantial growth rate of skin cancer has necessitated adequate protection from solar radiation. Consequently, analyzing sun protection practices is an imperative research area in dermatology and pharmacology.

AIMS

This paper aims to analyze public sun-protection manners in the Arabian Peninsula regions.

METHODS

A simple random survey was conducted to assess public sun protection manners. Artificial neural network (ANN) and support vector machine (SVM) were selected from several machine learning algorithms to create the models for predicting public sun protection measures based on the prediction accuracy. Model performances were evaluated based on several performance indicators depending on the confusion matrices and receiver operating characteristic curves.

RESULTS

51% of the respondents have a low level, and 49% have a high level of sun protection practices. The results showed that the SVM performed considerably amended than the ANN for predicting the response. The relative importance of the predictors for the best predictive SVM model was also analyzed. The predictors are ranked as: the number of times having sunburnt >gender > use seat belt while driving/riding a vehicle >considers the UV index for personal sun exposure >income based on the expenses >sports/exercise activities >consciousness of the chance for having sunburnt on extended exposure to the sun >age > having any skin problem >nationality > skin type.

CONCLUSION

These identified significant predictors might be considered for developing an effective policy to increase public consciousness using proper protection from solar radiation's detrimental effect to rule out skin diseases.

Sun Awareness and Sun Protection Practices

Background

The incidence of skin cancer has increased over the past few years, owing to excessive exposure to ultraviolet (UV) radiation. Over the past decade, protection against solar radiation has been highly encouraged in numerous public health education campaigns. The adopted sun protection practices include avoiding exposure to the sun, using protective clothing, and applying sunscreen. The aim of this paper was to analyze the awareness and attitudes towards sun protection practices in some regions of the Arabian Peninsula.

Objective

The main objective of this study is to estimate the level of sun protection practices and determine the factors that have a significant impact on the level of adoption of sun protection practices by residents in the Arabian Peninsula.

Methods

A 35-question self-reporting online questionnaire to evaluate the sun protection measures adopted by the residents was distributed in the Kingdom of Saudi Arabia and Kingdom of Bahrain. The survey was conducted from January 2018 to May 2019, and a total 830 responses were collected for analysis. The data were analyzed using the statistical software SPSS. The chi-squared test and Spearman's correlation were performed to determine the association of the sun protection level with factors concerning the socio-demographic characteristics, sun sensitivity, health-conscious lifestyle, adopted sun protection measures, and general awareness about the UV index, skin cancer, and vitamin D. Logistic regression classification was applied in developing the empirical model to predict the sun protection level of the residents.

Results

Based on the analysis, only 34% of the total 830 respondents use sunscreen and most of the sunscreen users are female. The three most popular sun protection practices are: 1) avoiding exposure to the sun during peak hours, 2) using protective clothing, and 3) using sunglasses. The results indicate that 22% of respondents use a low level of sun protection, 53% use a medium level of protection, while 25% of respondents use a high level of sun protection. Many of the respondents understand that exposure to the sun can cause skin cancer and skin aging, while 54% of the respondents still believe that a suntan can be healthy if sunburn is avoided. Thirty percent of the participants of this study are aware of the UV index, and only 20% of all respondents know the correct meaning of the UV index. The overall predictive accuracy of the constructed logistic regression model is 67%. Based on the results of the logistic regression model, the five most significant factors of the sun protection level are: 1) perception that the sun can cause skin aging, or not, 2) age, 3) awareness of the dangerous effects of sun exposure, 4) income with respect to expenses, and 5) taking the UV index into consideration during exposure to the sun.

Conclusion

Most of the respondents are aware about sun protection. However, the sun protection level of the residents is still inadequate. An efficient strategy of increasing the awareness of the effective use of sun protection systems must be established based on the significant factors to prevent skin cancer.

Solar Ultraviolet Exposure in Individuals Who Perform Outdoor Sport Activities

BACKGROUND

Skin cancer is the most common cancer in the USA. Therefore, it is important to review the contribution of ultraviolet radiation (UVR) exposure to skin cancer in individuals with the highest risk. Documenting the relationship between outdoor sports solar ultraviolet exposure and their risk of skin cancer along with appropriate risk mitigation strategies can help inform clinicians of practical information for counseling sun protective behaviors in this population.

METHODS

We conducted a review of the current evidence using PubMed to answer the following research questions: (1) How is ultraviolet radiation measured? (2) What is the modern utility of the ultraviolet index in modifying recreational sun protection behaviors? (3) What is the risk of developing skin cancer for outdoor sport participants? (4) What is the prevalence of skin cancer in sport participants? and (5) Is the number of nevi and solar lentigines elevated in outdoor sport participants?

RESULTS

Based on the literature, individuals who practice outdoor sport-related activities receive high ultraviolet radiation exposure, have a high risk for skin cancer, have a high prevalence for pigmented lesions, and may benefit from electronic sun protection educational interventions.

CONCLUSIONS

Individuals who practice outdoor sports experience substantially higher ultraviolet radiation exposure, routinely exceed the recommended exposure limits, and are at a higher risk of developing skin cancer. Therefore, those who are frequently engaged in outdoor leisure activities should be coached about efficient sun protective practices and relevant mobile technologies that may facilitate adherence.

The extent of public awareness, understanding and use of the Global Solar UV index as a worldwide health promotion instrument to improve sun protection: protocol for a systematic review

INTRODUCTION

(Over)exposure to ultraviolet radiation is a major risk factor for skin cancer. The Global Solar Ultraviolet Index (UVI) was introduced by the WHO and partner organisations in 1995 as a simple measure of the intensity of solar UV radiation, providing guidance for the population to use appropriate sun protective measures. Little is known about the impact of the UVI on actual sun protection behaviour. Our systematic review aims to assess global levels of awareness, understanding and use of the UVI as prerequisites for the preventive effectiveness of this public health tool.

METHODS AND ANALYSIS

Systematic searches will be performed in 10 electronic literature databases including Medline, Scopus and Web of Science-Core Collection, two clinical trials registries and at least two grey literature databases (OpenGrey, Bielefeld Academic Search Engine). Additional literature sources will be retrieved using hand search of reference lists of included studies and snowballing methods. We will include studies with all types of quantitative study designs and participants reporting on at least one outcome in the three main categories (i) awareness, (ii) understanding and (iii) use of the UVI. We will assess the risk of bias within studies with an abbreviated version of the AXIS tool, designed specifically for cross-sectional studies. As we expect large heterogeneity in outcomes, we will conduct a narrative synthesis of results instead of a meta-analysis.

ETHICS AND DISSEMINATION

Ethical approval and patient consent are not required as this is a systematic review based on published studies. The results of this study will be published in an international peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42018093693.

Awareness, understanding, use, and impact of the UV index: A systematic review of over two decades of international research

The ultraviolet radiation index (UVI) was adopted internationally to raise awareness about and encourage the public to protect their skin from skin cancer. The current paper is a systematic review of over 20 years of research investigating awareness, comprehension, use, and impact of the UVI. Thirty-one studies were included from the USA, Canada, Europe, Australia, New Zealand, and elsewhere. Awareness of the UVI varies by country, with samples from some countries demonstrating high awareness. However, comprehension and use of the UVI to inform sun safety behaviors are typically much lower. In fact, greater UVI awareness has sometimes been associated with riskier UV-related behaviors such as intentional tanning. Fewer studies have evaluated interventions, and their results have been mixed. In summary, more research is needed to determine how to help the public understand and use the UVI for effective skin protection. This review offers suggestions for future use of and research with the UVI.

Uptake of skin self-examination and clinical examination behavior by outdoor workers

This study investigated the association between outdoor work and response to a behavioral skin cancer early detection intervention among men 50 years or older. Overall, 495 men currently working in outdoor, mixed, or indoor occupations were randomized to a video-based intervention or control group. At 7 months post intervention, indoor workers reported the lowest proportion of whole-body skin self-examination (wbSSE; 20%). However, at 13 months mixed workers engaged more commonly in wbSSE (36%) compared with indoor (31%) and outdoor (32%) workers. In adjusted analysis, the uptake of early detection behaviors during the trial did not differ between men working in different settings. Outdoor workers compared with men in indoor or mixed work settings were similar in their response to an intervention encouraging uptake of secondary skin cancer prevention behaviors during this intervention trial.

[Understanding and use of the global solar UV index ("UV index") by French dermatologists]

BACKGROUND

The principal risk factor for development of skin cancers is exposure to ultraviolet (UV) radiation. The universal solar UV index (UVI) consists of a simple measurement of UV radiation at the earth's surface, which provides an indicator of the risk of skin lesions in the absence of protective measures and taking into account individual phototype. The UVI is recommended by the WHO and is used to educate populations about the need to take protective measures in the event of exposure to UV radiation. There have been very few studies to assess understanding of this index, and these have been conducted primarily among the general population. Our study assesses understanding and use of the UVI among dermatologists in metropolitan France.

MATERIALS AND METHODS

This survey was conducted in December 2011 among 400 randomly selected French dermatologists. The questions asked concerned their personal and professional knowledge and their use of the UVI.

RESULTS

We analysed 165 (41.5%) of the answers. The UVI was known to 79% of the dermatologists questioned. Less than one third of dermatologists knew the key values in the UVI. Less than half of the dermatologists aware of the UVI reported acting upon the values in question. Only 12.1% of the dermatologists said that they used the index in their communication concerning prevention of sunburn.

DISCUSSION

The results of our study show that the UVI is poorly known and not very widely used among dermatologists in France. This index, readily understood by anyone, could be incorporated by dermatologists in their prevention messages concerning solar radiation and it could be used throughout the year, particularly in target populations such as schoolchildren and children taking part in outdoor sports.

Is the Global Solar UV Index an effective instrument for promoting sun protection? A systematic review

Exposure to ultraviolet radiation is an important risk factor for skin cancer. The Global Solar Ultraviolet Index (UVI) was developed as a tool to visualize the amount of harmful radiation and to encourage people to use sun protection. We conducted a systematic review of the effectiveness of the UVI. We employed a comprehensive search strategy to explore the impact of the UVI on five outcome categories. Twenty-seven of a total of 260 studies met our inclusion criteria; data extraction and quality appraisal were undertaken for 25 studies, comprising 3 randomized controlled trials, 2 non-randomized intervention studies and 20 cross-sectional studies. Nearly half of these studies were from Australia and New Zealand. We found low to intermediate levels of UVI awareness and low levels of UVI understanding. Studies rated moderate or strong suggest that the UVI does not influence knowledge, attitudes, sun protection behavior or sun exposure. Overall, the findings imply that the UVI, as currently implemented, has not been successful at improving sun protection practices and reducing sun exposure among the population at large. Drawing on experience with theory-based sun protection programs, we advocate for more realistic expectations of what the UVI can and cannot achieve.

The influence of the UV-index on attitudes toward sun exposure in the German population

The increased skin cancer incidences are important public health problems. In spite of the strong promotion of the UV-index as essential UV risk education tool, only few studies have investigated peoples understanding of the UV-index. This paper is the first to present representative data on UV-index understanding in Germany. In 2007, a representative telephone survey was carried out among 1,501 German residents aged 14 years and older. Only 27% of the respondents had heard of the UV-index before and 17% of the German respondents claimed to consider the index for their sun habits. Less than 10% of the German population was able to attribute the correct meaning to the UV-index as well as know their own skin type. The results of the present study suggest that informing the public about the UV-index has very limited impact on the public's understanding of the UV-index as well as on their attitude toward sun exposure. The results warrant the question whether the UV-index in the present form is a useful education tool in UV risk communication.

Mass media barriers to social marketing interventions: the example of sun protection in the UK

The role of the mass media in communicating health-related information to the wider population is the focus of this paper. Using the example of sun protection within the UK, we highlight some of the major challenges to raising awareness of steadily increasing melanoma rates and of effective sun protection strategies. The implications of potential barriers to official sun protection messages via conflicting messages in the media are discussed in terms of editorial on sun protection and in the way in which television programme content portrays the issues. Implications for public policy and future research conclude the paper.

Weekend sun protection and sunburn in Australia trends (1987-2002) and association with SunSmart television advertising

BACKGROUND

The Australian state of Victoria has run a population-based skin cancer prevention program called SunSmart since 1988, incorporating substantial public education efforts and environmental change strategies. Trends over 15 years in behavioral risk factors for skin cancer were examined in a population exposed to the SunSmart program. Whether outcomes were associated with extent of SunSmart television advertising was then assessed.

METHODS

In nine cross-sectional surveys from 1987 to 2002, 11,589 adults were interviewed by telephone about their sun exposure and sun protection during outdoor activities on summer weekends. Analyses completed in 2007 adjusted for ambient temperature and ultraviolet radiation.

RESULTS

Sun protection and sunburn show substantial general improvement over time, but have stalled in recent years. Use of hats and sunscreens significantly increased over time and peaked during the mid to late 1990s, compared with the pre-SunSmart baseline. The mean proportion of unprotected skin was reduced and was lowest in the summer of 1997-1998. Summer sunburn incidence declined over time and was 9.1% in 2002, almost half baseline (OR=0.53; 95% CI=0.39-0.73). Higher exposure to SunSmart advertising in the 4 weeks before the interview increased: (1) preference for no tan, (2) hat and sunscreen use, and (3) proportion of body surface protected from the sun.

CONCLUSIONS

The general improvement in sun-protective behaviors over time highlight that a population's sun-protective behaviors are amenable to change. Population-based prevention programs incorporating substantial television advertising campaigns into the mix of strategies may be highly effective in improving a population's sun-protective behaviors.

Public (Mis)understanding of the UV Index

The ultraviolet index (UVI) has been regularly reported in Australia for a decade but utilisation remains extremely low ( approximately 5%). Blunden, Lower, and Slevin, in a 2004 Journal of Health communication article, suggest that Australians' understanding of the UVI is "good," and education to increase awareness of the index is therefore no longer warranted. To test this position, focus groups were conducted followed by an intercept survey of 404 residents of Perth, Western Australia, aged 16-44 years, to explore understanding and familiarity with the UVI. Results suggested that far from being "good," the familiarity and understanding of the UVI of at least half of Australians is poor. This was exemplified by the following: mean estimations of average UVI values in summer and winter being highly exaggerated (19.8 and 11.8, respectively); 61.2% not appreciating that the UVI is independent of temperature; at least 55.0% not appreciating that UV conditions peak at solar noon; and 23.3% of 22-44 year olds confusing the UVI with a "burn-time" measure. People who do not understand the UVI are unlikely to utilise it effectively. It therefore remains possible that utilisation of the UVI remains low because understanding is poor. Future efforts to improve utilisation of the UVI, particularly among those looking at new display formats, may therefore be ineffective, unless they also incorporate strategies to facilitate understanding of the measure.

Solar UV Forecasts

This study examined the effectiveness of solar UV forecasts and supporting communications in assisting adults to protect themselves from excessive weekend sun exposure. The study was conducted in Australia, where 557 adult participants with workplace e-mail and Internet access were randomly allocated to one of three weather forecast conditions: standard forecast (no UV), standard forecast + UV, standard forecast + UV + sun-protection messages. From late spring through summer and early autumn, they were e-mailed weekend weather forecasts late in the working week. Each Monday they were e-mailed a prompt to complete a Web-based questionnaire to report sun-related behavior and any sunburn experienced during the previous weekend. There were no significant differences between weather forecast conditions in reported hat use, sunscreen use, sun avoidance, or sunburn. Results indicate that provision of solar-UV forecasts in weather forecasts did not promote markedly enhanced personal sun-protection practices among the adults surveyed.

Knowledge, awareness, and use of the UV index amongst the West Australian public

The ultraviolet (UV) index provides an opportunity to warn people about the degree of hazard that exists on a particular day and subsequently lead to the adoption of sun protective behaviors. While the UV index has been promoted in Australia for some time, little research has been conducted into the understanding and use of the index. As such, a random telephone survey of 501 adults was conducted in December 1999 to gather data into the public's understanding and use of the UV index in Perth, Australia. A high awareness of the UV index existed among the respondents, with 90% indicating they had heard of the term UV index. However, only 5% indicated they had noticed the UV index/forecast for that particular day. The results indicate that a campaign to increase awareness of the UV index by the public is not warranted, but that efforts should be focused on developing tools to communicate behavior change messages linked to the UV index levels. The research was conducted with funding from Healthway, Health Promotion Foundation of Western Australia.